Politics of health care with emphasis on California legislation including workers compensation and utilization review and federal legislation in Washington, DC

Monday, December 5, 2016

The R & R Ride for SB 1160 (Mendoza)

Now that Governor Brown signed SB 1160 (Mendoza) into law, it's time for the bill to enter the "rulemaking" phase. That's when legislation either gets its teeth or gets its teeth kicked in. The Rules and Regulations (R&R) Ride for SB 1160 (Mendoza) starts at the Hiram Johnson State Office Building at 455 Golden Gate Avenue, San Francisco, 10 AM, 4 January 2017. Public testimony is supposedly limited to 10 minutes per speaker. The subject will be Title 8, CCRs, Section 10770 (amended) and 10770.7 (newly adopted).

Here is our opinion: implementation of SB 1160 (Mendoza) needs to be far more friendly to injured workers than it currently is. The Rules and Regulations (R & Rs) as proposed will implement a lien process that may be expanded in the sense that it will apply not only to doctors who accept liens but also to any physician or other provider who runs into snags with payment so that the only way remaining to proceed with an unpaid claim is through the lien process. That means if the lien process becomes the only viable option for a delayed or denied payment for medical or other service it will be necessary to file a lien under new R & Rs. That means increased crunch and grind especially for small offices. In turn that means progressive reduction in access to care for injured workers.

We also believe that a hint of hypocrisy persists in the process.Here's how: supposedly, treating doctors will get the first 30 days of treatment unimpeded by Utilization Review. Not quite. Not all procedures will be removed from the UR Cauldron of Dismissal: MRI scanning will remain off limits. So will non-formulary medications and durable medical equipment costing over $250. Psychological treatment will remain on the proscribed list (remember in 2015 that Neuropsych QME was unilaterally and arbitrarily canceled by the Director).

Surgery will still require prior authorization by UR.

For these reasons, we urge participants with a stake in this process to file statements:

Subscribe To

Follow by Email

Subscribe by RSS

Share This

View My LinkedIn Profile

About Me

Writing in Neurology Today, Vol. 3 (8), August 2003, Dawn Antoline writes "Robert L. Weinmann, MD, has never been one to shy away from controversy. Whether he is writing muckraking editorials about HMOs that deny physician claims or ... billing practices ... he has committed himself to a life of activism. At the heart of his advocacy is a passionate regard for his patients -- and the ability of physicians to provide unfettered optimal care."